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As we have clearly seen chemical dependency is a complex interwoven web of symptoms and issues. As the addiction unravels and the addict begins recovery we will need to support new strands with which they may reweave their life. As mentioned in the previous chapter the twelve step programs will be integral to this process. A life of recovery requires the adjustment of the addict physically, emotionally, socially and spiritually as well as a subsequent change in the lives of the enablers.
Therapeutic skills
to especially remember when working with an addict or an enabler include:
1.
Very clear boundaries
are necessary because addicts often have learned to be quite manipulative as
a survival skill. Their entitlement will test your limits around time, money,
etc. This may sound judgemental or harsh; that is not our intent. These characteristics
are defenses formed to serve the denial of the addict, and is the reason why
the best therapists for addicts are often recovering addicts.
2.
Establishing Rapport
is very important,
as trust is essential for the addict and the enabler to face the pain, the emptiness
and the isolation. Creating a safe container, a place where the client feels
seen for who they are and for their highest self, is fundamental to all successful
therapy.
3.
Neutrality
can be difficult
for therapists; we want our clients to get better, and can experience negative
countertransference when they don't. The key here is to be non-judgemental,
and detached as to the outcome. This breaks the cycle in which the therapist
becomes the enabler.
4.
The
Ability to confront
(gently!!)
is necessary
to break through the entrenched system of denial. Using examples from the client's
own story is the most effective means; such as with a college freshman who had
recently had a series of disappointing relationships, including a date rape.
When the therapist said: "Whenever you say 'partying' you mention a lot
of alcohol use; the guys you meet when you are both loaded don't seem to look
so good in the morning" the student began a long hard look at her alcohol
use.
5.
Compassion
is vital
in all healing work. It is the ability to be totally present for the client
in the moment, in the pain. It is not sympathy, or pity, but rather a 'feeling
with' the person. This allows the therapist to not judge, but rather to hear
the tears, to not fix, but rather hold the vision that we are all on this little
planet struggling for wholeness.
6.
Detachment combined with caring
is
what 'warms up' the neutrality. The addict or enabler must know you care, but
ultimately must undertake the healing journey for themselves, not to please
you.
7.
Holding hope
is crucial, although it may be something you never verbalize to the client.
Therapists who trust that there is a core in each of us that wants us to be
healed and whole transmit through the unspoken countertransference an optimism
that can carry the therapy during times of despair.
It is very important to assess psychologically whether there is a dual diagnosis appropriate to the client. Many clients can self-medicating . Prominent dual diagnoses include Obsessive-Compulsive Disorder, Attention Deficit Disorder, Bipolar Disorder, Anxiety, Schizophrenia, Panic Disorder, Post Traumatic Stress Disorder and Depression. With these conditions it is essential to get psychiatric evaluation and supervision for possible medication.
The assessment for chemical dependence can also help the clinician build a repertoire of incidents which can be used in confronting the client as to the depth and impact of their addictive process. Remember the best way to confront denial is with material directly given by the addict as the relationship between the addiction and other symptomology is drawn it becomes harder for the client to maintain their illusion that their drinking or drug use is not hurting anybody or anything. We have found that when investigating and confronting drug use that it is important to have a neutral, non-judgemental tone. When the client says they are going to stop using continue the confrontive approach of identifying :
1.How
will they stop their usage?
2.
How many times before have they tried to stop? To what ends?
3.
What will they do with the time they will have when they are not using?
4.
Do they have non-using friends?
5.
Who will they talk to when they craving intensifies?
6.
What will make this attempt to stop using different than other previous tries?
7.
Will they attend Twelve Step Meetings? How often?
It almost a certainty that an addict trying to quit outside of a treatment program will have the grandiose ideas that they do not need help from programs such as the Twelve Step or other chemical dependency support groups. Unless court ordered, most therapists do not demand their attendance as part of therapy. When their attempt at recovery fails, which it most often does, you can then strongly point out that it is next to impossible to quit alone and although they may not be like all the other people at these meetings they do share a common struggle and goal: "the desire to quit using drugs." Although the failure or relapse is never welcome it can signal an important turning point in therapy and a further unraveling of the web of denial. As a therapist we must never forget that during that first shaky year of recovery there is no more important therapeutic issue than recovery.
Emotionally, you should not waver into complacency and enabling by believing everything is fine and things are being handled well just because the client says so. It is rare that they could jump from a defended strategy of addiction to being able to cope with life and all its ups and downs without new resources. Stress reduction and relaxation techniques can be very valuable. Again, remember your task is to help someone grow up to their correct age, and that develop may well be stalled at the age the chemical dependency started. They may not have many ideas how normal the stresses of daily life are, nor many good coping strategies.
Socially , the twelve step programs provide emotional support and new activities and relationships for the recovering person to explore. Remember it really helps to talk to someone who has been there . Chemically dependent people often try to do the opposite and try to only be around people who have never used . This will further intensify their feelings of being different and isolated. It is important to note that one of the main characteristics for chemical dependency is drinking or using alone. Addicts and alcoholics will talk about this dynamic of getting high as the feeling of being with an old friend, something that was reliable, showing up in the same manner time after time. Church groups, health clubs and meaningful volunteer work can all be arenas for new relationships. The possible pitfall is that the recovering person will jump in with the same intensity that they have approached their addiction and will try to be everything to everybody in order to make up for all their previous transgressions. Two popular twelve step sayings are: One day at a time and Keep it simple.
Spiritually, the addict needs to find their motivation to embrace life and become alive to the moment. As they may have frequently found the moment too difficult to embrace previously it is important to take this slowly. Consistently help them try to rediscover the things they enjoyed doing. If they are thrill seekers explore other alternatives; we know of recovered addicts who have discovered skydiving, scuba diving, skiing, bungee jumping and other high risk sports. If they enjoy music or painting remind them that money spent on these pursuits is usually far less than they were spending to get high. These are things that reaffirm the human spirit. this is the beginning of addressing the emptiness that may lie underneath the addiction. In twelve step fellowships the basic spiritual tenet of recognizing one's self in the lives of others is perhaps one of its most profound therapeutic affects.
Preventing
relapse requires not buying into the idea that recovery is a one-two-three part
process with a beginning ,middle and end. It is an ongoing , lifetime process
that needs to be attended to as such. Old patterns take time to fade; new ones
take time to establish and be integrated.
1.How
will they stop their enabling? (Is
this sounding familiar? We want to emphasize how similar recovery from enabling
is to recovery from addiction.) It
almost a certainty that an enabler trying to quit being codependent outside
of a treatment program will have the grandiose ideas that they do not need help
from programs such as the Twelve Step or other codependency support groups.
Remember, the great illusion in both addiction and coaddiction is that of being
in control. Almost universally, enablers initially resist group treatment, so
it is important to undercut this resistance.
2.
How many times before have they tried to stop? To what ends?
3.
What will they do with the time they will have when they are not enabling?
4.
Do they have any friends?
5.
Who will they talk to when the addict uses; not in the old way about the addict;
but about themselves?
7.
Will they attend Twelve Step Meetings? How often?
Emotionally, the enabler will need continued support to focus on his or her own feelings and needs. Anticipate initial resistance, then regression as floods of feelings arise. Beware that enablers are caretakers, and may try to take care of you in the sessions. Beware of wavering into complacency and enabling by believing everything is fine and things are being handled well just because the client says so. As with addicts, stress reduction and relaxation techniques can be very valuable for enablers.
Socially ,the twelve step programs provide emotional support and new activities and relationships for the enabler to explore. Remember it really helps to talk to someone who has been there . Church groups, health clubs and meaningful volunteer work can all be arenas for new relationships. The possible pitfall is that the recovering codependent person will jump in with the same intensity that they have approached their addiction and will try to be everything to everybody in order to make up for all their previous transgressions. Two popular twelve step sayings are: One day at a time and Keep it simple.
Spiritually,
the coaddict needs to find their motivation to embrace life and become alive
to the moment. As they may have frequently found the moment too difficult to
embrace previously it is important to take this slowly. As with addicts, enablers
will face their empty center at some point in recovery. There may be great grief
as they experience how little they have honored their own path, and there may
be a flood of activity to avoid confronting the "empty hole" in their
center. The spiritual and the creative are two primary ways to fill this; beware
the impulse they will have to fill it with another person, or different concerns
about the addict (i.e. their blood pressure, rather that their drinking.) Art
and spirituality are things that have reaffirmed the human spirit since ancient
times. In twelve step fellowships the basic spiritual tenet of recognizing one's
self in the lives of others is perhaps one of it's most profound therapeutic
affects. Many recovering people have also found solace in publications such
as Meditations for Women Who Do Too Much by Anne Wilson Schaef or the
Daily Word by Unity Church.
Working with addicts and their families can be extremely rewarding as you participate in the journey of someone to become more fully human, more real and more themselves. Beware that almost every part of your psyche will be engaged, and you too will become more alive and more fully human. Good Luck!
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